Big plans for electronic health data are breaking out all over the healthcare field, with real consequences for providers, health plans and government regulators, all of whom now have an unquenchable thirst for information.
To ensure the right results, the informatics profession must step up and assert its expertise, according to the American Medical Informatics Association, which is working on how best to get members into the action.
The 5,000-member group, which has supported advancement of the science and application of informatics in healthcare, has set its sights on plugging experts into conversations taking place in Washington and wherever else there are policies and programs that use informatics, says Douglas Fridsma, MD, who took over as president and CEO in 2014 after four years directing technical and standards initiatives at the Office of the National Coordinator for Health Information Technology.
“If we want to make a difference, we have to stop defining informatics just in terms of what we know. In addition to that, we have to define informatics in terms of what we do,” says Fridsma.
It’s been barely a decade since the federal government launched efforts to shift data from being buried in paper charts to freed-up in digital form. In that time, the role of electronic health records in everything from alternative delivery models of care to e-measures of quality performance has made the intelligent deployment of this information essential to any odds of success. Amid the rapidly rising importance of data deployment, “AMIA has been kind of a sleeping giant,” says Jeffery Smith, vice president of public policy.
Fridsma, a career informatician and AMIA member before his stint at the ONC, remembers that “we would get a line of folks that would be coming through ONC with their perspectives on the best way to implement meaningful use, to deploy health information technology, to improve patient care using health information technology, but the informatics community was absent oftentimes from those conversations.”
Much of the advice dealt tactically with capturing and facilitating electronic data, but a more strategic approach was needed, something that informatics supplied, he explains. “It’s not just about, ‘Here’s the data, how do we analyze it.’ You need to understand the context in which it was collected. You need to understand how it can be integrated into the work process. You need to understand something about how to code so that it can be consistently used.”
One hot spot for informatics expertise is the continuing development of clinical quality measures in an electronic environment. The future of reimbursement rests on the ease of use, fairness and consistency of quality metrics gathered electronically. Although quality measures play a role in meeting meaningful use criteria, their significance has been limited to qualifying for federal incentives.
But that’s soon changing—measurement efforts now underway in connection with the incoming Merit-based Incentive Payment System (MIPS) will determine how providers are paid for value-based care, says Fridsma. “It means a whole lot more to get that right.”
In comments submitted to CMS February 1 in response to a request for information, AMIA urged the federal agency to “reimagine” quality measurement, saying the process needs a more fundamental overhaul rather than just enhancements to current measures.
Quote"Without consistency in the building blocks, we’re going to have thousands and thousands of variations in how we measure quality and how we extract the information.”
“We don’t have right now a clear and concise set of building blocks that could be used to develop quality measures,” Fridsma asserts. The federal effort does include good proposals and a commitment to standards, “but I have a fear that without consistency in the building blocks, we’re going to have thousands and thousands of variations in how we measure quality and how we extract the information.”
To operationalize the MIPS approach and other elements affecting clinical care and payment in the Medicare Access and CHIP Reauthorization Act (MACRA), regulators appear poised to enlist medical specialty societies in determining priorities for quality measures and designing them, says Smith.
Along with that delegated authority, “there becomes another need, not just to help the government figure out what a good informatics-related policy looks like, but to educate the specialty societies on what informatics really entails,” he says. That includes strategic thinking on how to collect and use data to fill in the picture.
Societies with which AMIA has had conversations “identify this as a critical need, they know they’re not experts in informatics. There’s a base level of competency that needs to be there for a 21st century doctor.”
AMIA has some competency training of its own to do if it’s going to lead the way, Fridsma says. It’s setting out to provide leadership opportunities internally, such as leading projects and working groups that equip informaticians to be leaders in their own institutions and, eventually, nationally.
“Oftentimes people who have a high degree of technical skills or even a high degree of clinical skills may or may not have the leadership skills that allow them to translate that expertise into actionable things,” he says.
To bring the membership along on any outward-facing endeavor, the association first must find a way to meld a diverse range of informatics viewpoints within its ranks, Smith says. The term itself is broadly defined, spanning clinical research, applied clinical informatics at the provider level, and public health informatics. That has created challenges, he says, because informatics means different things to different people in AMIA’s membership.
Many hail from a different time, back when EHRs were first designed in teaching hospitals. The position of informatician evolved in response to the combination of clinical and technological factors in play. As commercially developed EHRs became widely adopted, the informatics role has morphed into helping providers optimize the technology they have implemented, in ways that will fundamentally improve care, diagnosis and the execution of treatment plans, says Smith.
“Clearly we have gotten past the point where EHRs are the play-toys of academic medical centers,” he says. “In many ways, EHRs have been commoditized. Now they’re a requirement to deliver care and get reimbursed by Medicare.”
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